RROHC notes the importance of developing good relationships with one another in order to meet the patient’s stated goals. A key factor in establishing these relationships is achieving the skill of clear, honest communication. Due to the stress of a fast paced, crisis riddled health care environment often the communication is strained, shortened, interrupted or simply does not occur. As a result conflict can develop when someone does not meet our expectations. In these situations, special skills should be utilized to confront the person involved in the unmet expectations to better understand the situation, realign mutual goals and prevent any negative outcomes for the patients we serve. These confronting conversations may be nurse to patient, nurse to doctor, nurse to aid/tech or numerous other combinations.

The authors focus their attention in this book on the need for people to be able to talk face to face about extremely important issues in which confrontation needs to occur. If they fail to hold these conversations and resolve the issue, simple problems can grow into chronic problems. There are various responses to conflict and how it is, or is not handled. Those who avoid conflict can live in tortured silence or at the other extreme become violent. Others avoid dealing with a difficult topic by trying to force their ideas on others, cut people off, overstate arguments, attack or resort to insults or threats. This book provides skill development suggestions to avoid the massive personal, social and organizational consequences that can occur if we do not effectively confront violated expectations.

The first chapters are based on what we should do to prepare for this type of conversation. The authors encourage us to think before we get caught up in emotion and act. It is important to consider what the real problem is that you want to discuss. Often the real problem may not be the most obvious, superficial issue that you originally believed when the situation first came to you attention. In preparing for this exchange they recommend role playing the conversation within our own head using the acronym “CPR”. C stands for content. Start by explaining in factual terms what has happened. “P” refers to pattern. Plan to communicate if and when this has happened in the past. Pattern issues acknowledge that problems have histories. Frequent and continued violations affect the other person’s predictability and eventually harm respect and trust. Past practice can often predict future behavior. “R” is the last portion to be discussed. “R” is for relationships. This is the point where the impact of this situation on the relationship between the sender and receiver should be noted.

Other chapters note concepts of human behavior and how self awareness in entering a confrontation can help promote a positive outcome. The authors note that when humans are in conflict with one another we often quickly think the worst of one another. Even if able to verbally withhold this negativism in our interactions, our non-verbal communication will still display these negative emotions to one another. Instead, we are encouraged to think to ourselves prior to a communication of this sort, “Why would a reasonable, rational and decent person do this?” Entering into the conversation with a positive, questioning spirit will assist in establishing a positive format for progress between those involved.

The conversation should be focused on clarifying the gap between what was expected and what was observed. Don’t play games, just explain the gap. While holding the conversation it is crucial that we promote a sense of safety for the person we are confronting. They must feel respected as individuals and that we are aware of and care about their goals. Establishing a mutual purpose is crucial for success.

One method of showing respect is to include the other individual in coming up with a solution to the problem experienced. It is often easier to tell someone what we want them to do differently in the future to avoid this conflict again. However, involving them can have numerous benefits. First it lets us hear their ideas and provides them with an opportunity to put their theories, feelings and experience on the table. Secondly when people are involved in coming up with a potential solution, they’re more likely to be motivated to implement it. A solution that is tactically inferior but has the full commitment of those who implement it may be more effective than one that is tactically superior but is resisted by those who have to make it work. The solution should be jointly developed to create shared solutions that serve a mutual purpose.

Some common hang-ups that should be avoided with confrontation include responding to anger with anger, ”one-upping” or becoming patronizing. These are usually in response to an emotional person or an emotional topic. Emotions don’t come from outer space. We create them ourselves. A person does something, we see it and then we tell ourselves a story. The story then leads to a feeling. If we want to deal with our own emotions, we have to deal with the stories we tell ourselves.

This book also includes suggestions on how to close a crucial confrontation. A key aspect is to close by summarizing a complete plan that assumes nothing. It leaves no details to chance. It sets clear and measurable expectations. The plan notes who does what, by when and includes a follow up date. This summary should be followed by a question to the other person for them to have a chance to give input or note issues that might otherwise cause problems. An example of a clarifying question might be, “Can you see anything else that we haven’t talked about that might cause a problem?”

Follow up checkpoints must then occur. Busyness can be interpreted as apathy. This harms both the relationship and the results. The purpose of the follow up is to see what the current status is, how things went, what worked and what didn’t. The intention is to be helpful and supportive.

This was an excellent book that discusses a topic we all have to deal with on an all too often basis. In addition to being well written it offers practical solutions in a clearly defined process. The inclusion of numerous examples and scenarios adds to the reader’s ability to incorporate this content into everyday life. It will definitely take a place in my quick reference library for ready access in the future.

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